GHB
GHB, or gamma hydroxybutyrate, is a naturally occurring compound similar to the neurotransmitter GABA that primarily acts as a central nervous system depressant. Medically, it has legitimate uses in general anesthesia and treating conditions like narcolepsy and insomnia. However, GHB is often misused as an intoxicant, euphoric, and allegedly as a "date rape" drug due to its colorless, odorless liquid form, which makes it difficult to detect when added to beverages. The substance became a popular club drug in the late 1990s, often used in conjunction with other substances like alcohol and MDMA.
GHB's effects are dose-dependent; lower doses may induce relaxation, while higher doses can lead to severe side effects, including confusion, nausea, and even coma. Due to its potential for addiction and the risks associated with overdose, GHB is classified as a Schedule I controlled substance in many countries, including the United States. Awareness and education about the dangers of GHB are vital, particularly among youth, to prevent misuse and the associated risks, including its involvement in sexual assault cases and a significant number of documented overdose deaths.
GHB
ALSO KNOWN AS: Cherry meth; easy lay; fantasy; g; gamma-oh; Georgia home boy; great hormones at bedtime; grievous bodily harm; g-riffick; goop; 4-hydroxybutanoic acid; jib; liquid e; liquid ecstasy; liquid g; liquid x; mils; organic Quaalude; salty water; scoop; sleep; sleep-500; sodium oxybate; vita-g; Xyrem
DEFINITION: GHB (gamma hydroxybutyrate) is a naturally occurring substance that resembles the neurotransmitter and energy metabolism regulator gamma-aminobutyric acid (GABA). GHB generally acts as an intoxicant and as a depressant of the central nervous system. Medically, GHB is used in general anesthesia and to treat narcolepsy, insomnia, clinical depression, and alcoholism. GHB is used illicitly as an intoxicant, euphoriant, “date rape” drug, and body-building supplement.
STATUS: Illegal in the United States, Australia, New Zealand, Canada, and most of Europe
CLASSIFICATION: Schedule I controlled substance; Xylem, the pharmacological preparation of GHB, is a Schedule III controlled substance
SOURCE: Naturally occurs in the human central nervous system and in nonhuman animals, wine, beer, and small citrus fruits. Drug suppliers can make GHB easily and cheaply from sodium hydroxide, which is found in drain cleaners and in gamma-hydroxybutyrolactone, a readily available industrial solvent.
TRANSMISSION ROUTE: Ingested as a white powder or a colorless liquid
History of Use
Russian chemist Alexander Mikhaylovich Zaytsev first reported the synthesis of GHB (gamma-hydroxybutyric acid) in 1874. French scientist Henri Laborit performed some of the first GHB research in the 1960s. In the late 1980s and 1990s, GHB was sold over the counter in the United States (US) as a body-building supplement and sleep aid. Increased incidents of GHB intoxication moved the US Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration (FDA) to issue warnings regarding its potential dangers.
In the late 1990s, GHB was used in several highly publicized drug-facilitated cases of sexual assault. Because of this, people labeled GHB a “date rape” drug. Because illicit formulations of GHB are commonly colorless, odorless liquids, the surreptitious addition of GHB to drinks in bars and clubs is difficult to detect. Also, several GHB side effects (sedation, euphoria, decreased inhibitions, enhanced sex drive, and mild amnesia) enhance its effectiveness in drug-facilitated cases of sexual assault. In 2000, the FDA placed Xyrem on the list of Schedule III controlled substances and listed nonmedical GHB as a Schedule I controlled substance.
During the 1990s, GHB became widely used as a club drug. Club or party drugs are used by people who attend nightclubs, raves, and other parties. These drugs include methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA, or ecstasy), lysergic acid diethylamide (LSD, or acid), and ketamine (special K). GHB, ecstasy, and ketamine are frequently used together, also in combination with alcohol, marijuana, and amphetamines.
The popularity of GHB as a club drug is largely due to the ease of its synthesis and its low cost. GHB is quite popular in dance clubs for persons younger than age twenty-one years, where alcohol is not sold; however, the youth in these clubs can drink water or other nonalcoholic beverages spiked with GHB. Club drugs related to GHB include gamma-butyrolactone (GBL) and 1,4-butanediol, both of which are liquids and found in paint strippers and varnish thinners. These chemicals are known as GHB “prodrugs” because they are converted to GHB by the body after ingestion.
Effects and Potential Risks
In the brain, cells called neurons generate and propagate nerve impulses. GHB exerts its effects by binding to specific receptors on the surfaces of neurons. GHB binds to the GABAB and GHB receptors. When it binds to the GABAB receptor, GHB causes sedation. Conversely, binding of the GHB receptor increases the release of the neurotransmitter glutamate, which is the principal excitatory neurotransmitter in the brain. Simultaneous activation of both the GHB and GABAB receptors at low GHB concentrations induces the release of the neurotransmitter dopamine in the ventral tegmental area (VTA). The VTA is one of the key reward regions of the brain, and dopamine release in the VTA produces a feeling of pleasure or satisfaction and is the reason for the addictive nature of GHB.
GHB induces sleep by binding GABAB receptors in the thalamocortical loop, which regulates sleep and arousal. Because GHB binds to the GHB receptor much more tightly than the GABAB receptor, decreases in the bodily concentration of GHB increase its stimulatory effects relative to its sedative effects. This causes people who have taken GHB to awaken abruptly after a particular time.
The effects of GHB are dose-related. At 10 milligrams per kilogram body weight (mg/kg), GHB depresses the central nervous system and causes a general sense of calm and relaxation. GHB doses of 20 to 30 mg/kg induce sleep for two to three hours. A dose of 40 to 50 mg/kg induces even longer periods of sleep but also causes amnesia, nausea and vomiting, dizziness, weakness, loss of peripheral vision, confusion, hallucinations, agitation, and low heart rate (bradycardia). Doses above 50 mg/kg cause seizures, unconsciousness, respiratory depression, and coma. GHB effects appear within fifteen minutes of oral ingestion, but the acute symptoms cease after seven hours.
Combining GHB with alcohol increases depression of breathing and can cause death. GHB is rather addictive, and long-term use can cause depression and suicidal tendencies. Between 1990 and 2019, the US reported more than 16,000 GHB-related deaths. However, these numbers may be more widespread than reported and on the rise. Deaths from acute GHB intoxication are difficult to verify due to the lack of toxicology screening for the drug and the ability of the body to excrete the drug rapidly. Education about the dangers of GHB is essential for youth because of the high risk of overdose, common misconceptions regarding the drug's safety, GHB's role in sexual assault, and its potential for addiction.
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